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      Benefits of Prolonged Angiotensin-Converting Enzyme Inhibition in Congestive Heart Failure

      Cardiology

      S. Karger AG

      Neurohumoral activation, Congestive heart failure, Circadian variations, Angiotensin-converting enzyme inhibitors

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          Abstract

          Normal individuals have time-dependent variations in cardiovascular function, most of which are circadian (once daily). They include changes in heart rate, systemic arterial blood pressure, cardiac output, blood volume, and viscosity. There are also changes in neuroendocrine function, including the sympathetic and parasympathetic nervous systems and the renin-angiotensin system. These variations have important consequences for the heart, since haemodynamic and neuroendocrine alterations determine cardiac work load; heart rate, blood pressure, and sympathetic nervous system activity are highest during the waking hours and lowest during sleep. Cardiovascular mortality and morbidity are associated with these changes. Patients with congestive heart failure undergo changes in neurohumoral cardiovascular regulation that increase the work load of the heart as a result of increases in heart rate and peripheral vascular resistance. Moreover, a normal circadian variation is lost, causing blood pressure and heart rate to remain increased at night, depriving the heart of a period of rest. In addition, these patients have an ability to increase blood flow to exercising skeletal muscle, limiting exercise tolerance, as well as the consequences of elevated ventricular filling pressures. These time-dependent variations in the pathophysiological processes of congestive heart failure have implications for pharmacological therapy. In particular, vasodilator therapy should be administered to provide optimal unloading of the heart throughout the day. Vasodilator therapy should also provide antagonism to those factors that limit blood flow to working skeletal muscle, so that the physical ability is not intermittently compromised during the trough effect of the drug. Criteria for establishing the efficacy of drugs for the treatment of congestive heart failure should include an analysis of peak and trough effects.

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          Author and article information

          Journal
          CRD
          Cardiology
          10.1159/issn.0008-6312
          Cardiology
          S. Karger AG
          978-3-8055-5461-9
          978-3-318-01893-6
          0008-6312
          1421-9751
          1991
          1991
          12 November 2008
          : 79
          : Suppl 1
          : 16-21
          Affiliations
          Cardiovascular Research Laboratory, Department of Medicine, Tulane University School of Medicine, New Orleans, La., USA
          Article
          174902 Cardiology 1991;79:16–21
          10.1159/000174902
          1680559
          © 1991 S. Karger AG, Basel

          Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

          Page count
          Pages: 6
          Categories
          Session I – Current Perspective

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